Provider Demographics
NPI:1760609234
Name:THATCHER, KELTA DARLENE
Entity Type:Individual
Prefix:MRS
First Name:KELTA
Middle Name:DARLENE
Last Name:THATCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11942 STERLING ROAD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106
Mailing Address - Country:US
Mailing Address - Phone:937-444-0855
Mailing Address - Fax:
Practice Address - Street 1:11942 STERLING ROAD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106
Practice Address - Country:US
Practice Address - Phone:937-444-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2687098171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications